Parasomnias Differential Diagnoses

  • Author: David Bienenfeld, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Mar 29, 2012
 
 

Diagnostic Considerations

Parasomnias often are misdiagnosed and inappropriately treated as psychiatric disorders. Experienced sleep professionals should evaluate patients with these disorders.

In addition to the conditions listed in the differential diagnosis (see below), other problems to be considered include the following:

  • Dissociative fugue
  • Epilepsy
  • Hypnagogic hallucinations
  • Sundowning
  • Major depression

Failure to look for an underlying cause for one of the parasomnias, especially when the onset is in adulthood, could be actionable.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Coauthor(s)

Ariz Anklesaria, DO  Resident Physician, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

Ariz Anklesaria, DO is a member of the following medical societies: American Medical Association and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of Health Sciences: Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Mohammed A Memon, MD Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

  1. Thorpy MJ, Glovinsky PB. Parasomnias. Psychiatr Clin North Am. Dec 1987;10(4):623-39. [Medline].

  2. Broughton RJ. Sleep disorders: disorders of arousal? Enuresis, somnambulism, and nightmares occur in confusional states of arousal, not in "dreaming sleep". Science. Mar 8 1968;159(819):1070-8. [Medline].

  3. Guilleminault C. Parasomnias. In: Kyger M, Roth T, Dement W, eds. Principles and Practice of Sleep Medicine. 2nd ed. Philadelphia, Pa: WB Saunders;. 1994:567-73.

  4. Rama AN, Zachariah R, Kushida CA. Differentiating Noctural Movements: Leg Movements, Parasomnias, and Seizures. Sleep Med Clin [serial online]. September 2009;4 (issue 3):Available from: MD Consult. Accessed 2/3/10. Available at http://bit.ly/gcrRg1.

  5. Allen RP, La Buda MC, Becker P, et al. Family history study of the restless legs syndrome. Sleep Med. Nov 2002;3 Suppl:S3-7. [Medline].

  6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association;. 2000.

  7. American Sleep Disorders Association. International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester, Minn: American Sleep Disorders Association;. 1990.

  8. American Psychiatric Association. Sleep Disorders. American Psychiatric Association DSM5 Development. Available at http://www.dsm5.org/ProposedRevisions/Pages/SleepDisorders.aspx. Accessed 5/5/2010.

  9. Cooper AJ. Treatment of coexistent night-terrors and somnambulism in adults with imipramine and diazepam. J Clin Psychiatry. May 1987;48(5):209-10. [Medline].

  10. Hurwitz TD, Mahowald MW, Schenck CH, et al. A retrospective outcome study and review of hypnosis as treatment of adults with sleepwalking and sleep terror. J Nerv Ment Dis. Apr 1991;179(4):228-33. [Medline].

  11. Schenck CH, Boyd JL, Mahowald MW. A parasomnia overlap disorder involving sleepwalking, sleep terrors, and REM sleep behavior disorder in 33 polysomnographically confirmed cases. Sleep. Nov 1997;20(11):972-81. [Medline].

  12. Schenck CH, Mahowald MW. An analysis of a recent criminal trial involving sexual misconduct with a child, alcohol abuse and a successful sleepwalking defence: arguments supporting two proposed new forensic categories. Med Sci Law. Apr 1998;38(2):147-52. [Medline].

  13. Chiu HF, Wing YK. REM sleep behaviour disorder: an overview. Int J Clin Pract. Oct 1997;51(7):451-4. [Medline].

  14. Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain. Feb 2000;123 (Pt 2):331-9. [Medline].

  15. Allen RP, Picchietti D, Hening WA, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. Mar 2003;4(2):101-19. [Medline].

  16. Allen RP. Race, iron status and restless legs syndrome. Sleep Med. Nov 2002;3(6):467-8. [Medline].

  17. Chesson AL, Wise M, Davila D, et al. Practice parameters for the treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Report. Standards of Practice Committee of the American Academy of Sleep Medicine. Sleep. Nov 1 1999;22(7):961-8. [Medline].

  18. Earley CJ. Clinical practice. Restless legs syndrome. N Engl J Med. May 22 2003;348(21):2103-9. [Medline].

  19. Garcia-Borreguero D, Odin P, Schwarz C. Restless legs syndrome: an overview of the current understanding and management. Acta Neurol Scand. May 2004;109(5):303-17. [Medline].

  20. Zaharna M, Budur K, Noffsinger S. Sexual Behavior during sleep: convenient alibi or parasomnia. Current Psychiatry. Jul 2008;7:21-30. [Full Text].

  21. Ebrahim IO. Somnambulistic sexual behaviour (sexsomnia). J Clin Forensic Med. Mar 23 2006;[Medline].

  22. Shapiro CM, Trajanovic NN, Fedoroff JP. Sexsomnia--a new parasomnia?. Can J Psychiatry. Jun 2003;48(5):311-7. [Medline].

  23. Gluck ME, Geliebter A, Satov T. Night eating syndrome is associated with depression, low self-esteem, reduced daytime hunger, and less weight loss in obese outpatients. Obes Res. Apr 2001;9(4):264-7. [Medline].

  24. Rand CS, Macgregor AM, Stunkard AJ. The night eating syndrome in the general population and among postoperative obesity surgery patients. Int J Eat Disord. Jul 1997;22(1):65-9. [Medline].

  25. Stunkard A, Berkowitz R, Wadden T. Binge eating disorder and the night-eating syndrome. Int J Obes Relat Metab Disord. Jan 1996;20(1):1-6. [Medline].

  26. Howell MJ, Schenck CH, Crow SJ. A review of nighttime eating disorders. Sleep Med Rev. Feb, 2009;13 (1):23-34. [Medline]. [Full Text].

  27. Mahowald MW, Schenck CH. Evolving concepts of human state dissociation. Arch Ital Biol. Apr 2001;139(3):269-300. [Medline].

  28. Gastaut H, Broughton RJ. A clinical and polygraphic study of episodic phenomena during sleep. Biol Psychiatry. 1965;7:197-221.

  29. Leo G. Parasomnias. WMJ. 2003;102(1):32-5. [Medline].

  30. Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology. Feb 1996;46(2):388-93. [Medline].

  31. Eisensehr I, Linke R, Tatsch K, et al. Increased muscle activity during rapid eye movement sleep correlates with decrease of striatal presynaptic dopamine transporters. IPT and IBZM SPECT imaging in subclinical and clinically manifest idiopathic REM sleep behavior disorder, Parkinson's diseas. Sleep. Aug 1 2003;26(5):507-12. [Medline].

  32. Stiasny-Kolster K, Trenkwalder C, Fogel W. Restless legs syndrome--new insights into clinical characteristics, pathophysiology, and treatment options. J Neurol. Sep 2004;251 Suppl 6:VI/39-43. [Medline].

  33. Eisensehr I, Ehrenberg BL, Noachtar S. Different sleep characteristics in restless legs syndrome and periodic limb movement disorder. Sleep Med. Mar 2003;4(2):147-52. [Medline].

  34. Pilon M, Montplaisir J, Zadra A. Precipitating factors of somnambulism: impact of sleep deprivation and forced arousals. Neurology. Jun 10 2008;70(24):2284-90. [Medline]. [Full Text].

  35. Silber MH, Richardson JW. Multiple blood donations associated with iron deficiency in patients with restless legs syndrome. Mayo Clin Proc. Jan 2003;78(1):52-4. [Medline].

  36. Wills L, Garcia J. Parasomnias: epidemiology and management. CNS Drugs. 2002;16(12):803-10. [Medline].

  37. Chokroverty S. Editor's corner: restless legs syndrome, a common disease uncommonly diagnosed. Sleep Med. Mar 2003;4(2):91-3. [Medline].

  38. Hening WA, Allen RP, Thanner S, et al. The Johns Hopkins telephone diagnostic interview for the restless legs syndrome: preliminary investigation for validation in a multi-center patient and control population. Sleep Med. Mar 2003;4(2):137-41. [Medline].

  39. Phillips B, Young T, Finn L, et al. Epidemiology of restless legs symptoms in adults. Arch Intern Med. Jul 24 2000;160(14):2137-41. [Medline].

  40. Nichols DA, Allen RP, Grauke JH, et al. Restless legs syndrome symptoms in primary care: a prevalence study. Arch Intern Med. Oct 27 2003;163(19):2323-9. [Medline].

  41. Rodrigues RN, Rodrigues AA, Pratesi R, Krieger J. Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas. Sleep Med. Mar 22 2006;[Medline].

  42. Schenck CH, Milner DM, Hurwitz TD, et al. A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry. Sep 1989;146(9):1166-73. [Medline].

  43. Plante DT, Winkelman JW. Parasomnias: Psychiatric Considerations. Sleep Med Clin [serial online]. 2008;3:217-219. Available at http://www.sleep.theclinics.com/article/S1556-407X(08)00006-4/abstract.

  44. Mahowald MW. What is causing excessive daytime sleepiness? Evaluation to distinguish sleep deprivation from sleep disorders. Postgrad Med. Mar 2000;107(3):108-10, 115-8, 123. [Medline].

  45. Mahowald MW, Schenck CH. Diagnosis and management of parasomnias. Clin Cornerstone. 2000;2(5):48-57. [Medline].

  46. Fantini ML, Gagnon JF, Filipini D, Montplaisir J. The effects of pramipexole in REM sleep behavior disorder. Neurology. Nov 25 2003;61(10):1418-20. [Medline].

  47. Picchietti D, Winkelman JW. Treatment of depression in patients with restless legs syndrome: What is evidence-based?. Sleep Med. Mar 23 2006;[Medline].

  48. Lesage S, Hening WA. The restless legs syndrome and periodic limb movement disorder: a review of management. Semin Neurol. Sep 2004;24(3):249-59. [Medline].

  49. Kushida CA. Pramipexole for the treatment of restless legs syndrome. Expert Opin Pharmacother. Mar 2006;7(4):441-51. [Medline].

  50. Hening W, Allen R, Earley C, et al. The treatment of restless legs syndrome and periodic limb movement disorder. An American Academy of Sleep Medicine Review. Sleep. Nov 1 1999;22(7):970-99. [Medline].

  51. Thorpy MJ. New paradigms in the treatment of restless legs syndrome. Neurology. Jun 28 2005;64(12 Suppl 3):S28-33. [Medline].

  52. Zaremba PD, Bialek M, Blaszczyk B, et al. Non-epilepsy uses of antiepilepsy drugs. Pharmacol Rep. Jan-Feb 2006;58(1):1-12. [Medline].

 
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Polysomnographic study demonstrates apnea (absence of carbon dioxide fluctuation indicating no flow), chest wall paradox, abrupt increase in tidal volume at end of apnea, and oxygen desaturation. All of these features are consistent with obstructive sleep apnea.
Periodic limb movements on polysomnographic study show intermittent leg electromyographic activity accompanied by electroencephalographic arousals.
 
 
 
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